Journal of Plastic, Breast & Reconstructive Surgery·査読制・オープンアクセスの外科症例報告誌査読制 · オープンアクセス
Nelson Ramirez Lozano. Case 10 2026: Propeller Flap Based on Two Perforators of the Scapular Artery for the Management of a Severely Traumatized Upper Extremity. Journal of Plastic, Breast & Reconstructive Surgery. 2026.
オープンアクセス。 © 2026 著者。Journal of Plastic, Breast & Reconstructive Surgery発行。本症例の著作権は著者と本誌が共有しており、著者は教育、プレゼンテーション、SNSなどの目的で自らの症例を再利用できます。
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Nelson Ramirez Lozano1
We present the successful case of a patient who sustained severe trauma to the upper extremity caused by a sugarcane mill (trapiche). We consider this type of trauma to be a reconstructive challenge given the significant degree of soft tissue compromise, the presence of infection in nearly all such cases, and the imperative need for these patients to return to their daily activities. A propeller flap based on two perforators of the scapular artery was designed and executed, enabling adequate reconstruction and wound coverage without generating donor-site morbidity, facilitating early rehabilitation and rapid functional recovery. Patient medical history A male patient sustained severe trauma to the left upper extremity involving a sugarcane mill during occupational activities. He was admitted to the emergency department, where hemostasis was achieved and hemodynamic stabilization was attained. On initial evaluation, no fractures were identified; however, the patient presented with humeral bone exposure, circumferential soft tissue loss involving the upper arm, restricted range of motion, and altered sensation. He subsequently underwent multiple irrigation and debridement procedures, as well as serial negative pressure wound therapy (NPWT) dressing changes performed by the Orthopedics and Traumatology service, achieving adequate control of necrotic tissue and resolution of infection. Plastic Surgery consultation was then requested. Before and After Patient examination The patient presented with a circumferential soft tissue defect of the left upper arm with exposed humerus, no active signs of infection, and an in-situ negative pressure wound therapy device. Physical examination a
BeforeAfterA male patient sustained severe trauma to the left upper extremity involving a sugarcane mill during occupational activities. He was admitted to the emergency department, where hemostasis was achieved and hemodynamic stabilization was attained. On initial evaluation, no fractures were identified; however, the patient presented with humeral bone exposure, circumferential soft tissue loss involving the upper arm, restricted range of motion, and altered sensation. He subsequently underwent multiple irrigation and debridement procedures, as well as serial negative pressure wound therapy (NPWT) dressing changes performed by the Orthopedics and Traumatology service, achieving adequate control of necrotic tissue and resolution of infection. Plastic Surgery consultation was then requested.
The patient
presented with a circumferential soft tissue defect of the left upper arm with
exposed humerus, no active signs of infection, and an in-situ negative pressure
wound therapy device. Physical examination at the time of plastic surgery
evaluation revealed no restriction in range of motion and no sensory deficits.
Given that
this was a rural worker, the reconstructive plan was designed with the
following objectives:
With
the patient in the lateral decubitus position, the cutaneous island is
designed. Note the substantial dimensions of the skin island and the
perforasome territory of the scapular artery perforators
se diseca toda la isal de piel
Two
perforators of the scapular artery are identified at their respective
Doppler-confirmed hot spots, upon which the flap is based. Note the
considerable size of the cutaneous island.
The patient
was admitted for a two-week inpatient stay for flap surveillance and monitoring
of perfusion. During the initial postoperative days, positioning in the lateral
decubitus was maintained to optimize flap perfusion. The patient subsequently
underwent a second-stage procedure for definitive closure of the donor site and
anterior surface of the upper arm using split-thickness skin grafts. Early
rehabilitation was initiated postoperatively, resulting in rapid functional
recovery and allowing the patient to return to his daily activities without
limitations.
